The aim of this study was to characterize the motion, morphology, and pressure of the upper esophageal sphincter (UES). The UES and its surrounding structures were evaluated in seven normal subjects and four human cadavers, using simultaneous high-resolution endoluminal sonography and manometry. The UES musculature on ultrasound is a C-shaped structure with an angle of 107 ± 19°. The mean peak resting UES pressure was 74 mm Hg, with a total cross-sectional area (CSA) of 0.87 ± 0.33 cm2. During swallowing, the UES moved in an orad direction. Localizing the UES sonographically, the peak UES pressure in the cadavers was 19.7 ± 10.0 mm Hg. The UES has a greater muscular CSA and resting pressure than the upper esophageal body. In the cadaver studies, the UES was imaged in conjunction with a significant increase in pressure, indicating that the pressure is due to passive mechanical conformational changes.

Background: Elevated variceal pressure leads to variceal bleeding. A simple device to noninvasively measure variceal pressure, and to determine the variables of variceal wall tension would allow the prediction of future variceal bleeding and the titration of medications to lower the intravariceal pressure. Purpose: To develop a noninvasive method which allows determination of intravariceal pressure. To develop a noninvasive method which will allow the determination of the variceal wall tension by measuring the variables of the Laplace equation, (transmural pressure, radius of the varix and wall thickness of the varix). To test this device in a model of esophageal varices. Methods: Two variceal pressure measurement devices were constructed. The first device consists of an Olympus UM-BS20-26R, 20 MHz ultrasound transducer placed next to a latex balloon catheter sheath with the balloon catheter attached to a pressure transducer. The second device was constructed by placing the same ultrasound transducer inside a latex contdom balloon attached to a pressure measuring device. These pressure measurement devices were tested in a blind fashion by inflating the balloon in order to compress and flatten each of four variceal models. Each variceal pressure was measured 10 times by two separate investigators blinded to the actual pressures within the model. The mean plus or minus the SD was calculated. The variceal models were made of a latex balloon filled with water. Each varix had the same diameter but a different intraluminal pressure. Results: The correlation coefficient between the actual and measured varix pressures for both devices ranged from .94 to .99. The percent error ranged from 0 to 10%. The correlation coefficient between the investigators making the blind measurements ranged from .97 to .99. Conclusion: Two variceal related pressure-measuring devices were developed, which are able to determine intravariceal pressure in a model varix system. These devices demonstrate a low percent error and a high correlation to the actual variceal pressures with low intra and interobserver variability. In addition to intravariceal pressure these devices have the potential to measure all to the variables of the Laplace eaquation for wall tension (transmural pressure, variceal radius and variceal wall thickness). We plan to test this device in human subjects.

OBJECTIVE:To develop a noninvasive method and device to determine intravariceal pressure and variceal wall tension by measuring the variables of the Laplace equation and test this device in a model of esophageal varices.METHODS:Two variceal pressure measurement devices were constructed. The first device consists of an Olympus 20 MHz ultrasound transducer placed next to a latex balloon catheter attached to a pressure transducer. The second device was constructed by placing the same ultrasound transducer inside a latex condom balloon attached to a pressure transducer. These pressure measurement devices were tested blindly in varix models with different intravariceal pressures, by inflating the balloon to flatten the varix models. Each variceal pressure was measured 10 times by two separate investigators blinded to the actual pressures. The mean intravariceal pressures were calculated. The variceal models were made of a latex balloon filled with water and coffeemate.RESULTS:The correlation coefficient between the actual and measured varix pressures for both devices was 0.99. The percent error ranged from 0 to 10%. The correlation coefficient between the investigators making the blinded measurements for both devices was 0.98.CONCLUSION:Two pressure-measuring devices were developed to determine intravariceal pressure in a model varix system. These devices demonstrate a low percent error and a high correlation to the actual variceal pressures with low intra- and interobserver variability. These devices have the potential to measure all the variables of the Laplace equation for wall tension. We plan to test these devices in human subjects.

Our hypothesis states that variceal pressure and wall tension increase dramatically during esophageal peristaltic contractions. This increase in pressure and wall tension is a natural consequence of the anatomy and physiology of the esophagus and of the esophageal venous plexus. The purpose of this study was to evaluate variceal hemodynamics during peristaltic contraction. A simultaneous ultrasound probe and manometry catheter was placed in the distal esophagus in nine patients with esophageal varices. Simultaneous esophageal luminal pressure and ultrasound images of varices were recorded during peristaltic contraction. Maximum variceal cross-sectional area and esophageal luminal pressures at which the varix flattened, closed, and opened were measured. The esophageal lumen pressure equals the intravariceal pressure at variceal flattening due to force balance laws. The mean flattening pressures (40.11 +/- 16.77 mmHg) were significantly higher than the mean opening pressures (11.56 +/- 25.56 mmHg) (P < or = 0.0001). Flattening pressures >80 mmHg were generated during peristaltic contractions in 15.5% of the swallows. Variceal cross-sectional area increased a mean of 41% above baseline (range 7-89%, P < 0.0001) during swallowing. The peak closing pressures in patients that experience future variceal bleeding were significantly higher than the peak closing pressures in patients that did not experience variceal bleeding (P < 0.04). Patients with a mean peak closing pressure >61 mmHg were more likely to bleed. In this study, accuracy of predicting future variceal bleeding, based on these criteria, was 100%. Variceal models were developed, and it was demonstrated that during peristaltic contraction there was a significant increase in intravariceal pressure over baseline intravariceal pressure and that the peak intravariceal pressures were directly proportional to the resistance at the gastroesophageal junction. In conclusion, esophageal peristalsis in combination with high resistance to blood flow through the gastroesophageal junction leads to distension of the esophageal varices and an increase in intravariceal pressure and wall tension.

compared to a historical control group who only received EVL to control the imtial variceal bleeding.Rebleeding rate were' calculated 6 months after eradication of the varices, or alter starting the medical treatment.Result: EVL efficiently controlled active vanceal bleeding in 95% of patients.Only 5 patients (5%) required a second endoscopic procedure within 48 hours to control the bleeding Rebleeding occurred in 12.5% in the Endoscopic intervention group alter repeated EVL, while in the SMT group rebleeding occuned in 8.5%, the difference was not statistically siguificant (p=0.5).However, the rebleeding rate was significantly" higher in the historical group, (26% versus 125% versus 8.5%) respectively (p=0.04).Conclusion: Medical therapy after initial control of variceal bleeding by band ligation is as effective as repeated band ligation in prevention of variceal rebleeding in ~histosomal/biCW co-mlected patients. GroupsControl (IEVL Once) Repeated EVL EVL followed by SliT % 26 12.5 8.5 p value 0.

A recent randomized study has shown that the long term effect of continous treatment of GERD with a proton pump (PPI) is comparable to that of open fnndoplication. No studies bav cnmpared the long term eflect of surgical treatment with that of modern medical treatment given according to clinical practice. We have performed a 3-10 years questionnaire based follow up study of 163 patients operated with laparoscopi fundoplication at one hospital, 108 patients operated with upen fundoplication at another hospital and matched patients with GERD treated medically according to clinical practice. The patients were matched tot age, sex, follow up time, degree of esophagitis and hospital. The questionnaires used for symptoms and heahh related quality of life were Gastrointestinal Symtom Rating Scale (GSRS) and Psychological General WelbBeeing index (PGWB), respectively'. The respense rates were about 80%. The surgically' treated patients had significantly less reflux symptoms than the medically treated patients, the mean scores beemg 1,34 and 2,51, respectively ( p < 0 , ~ l . The operated patients also used signtfieantly less antireflux drags (p<0,01). No consistent signiticant differences were fouud for quality of life (Qol.), but m both hospitals there was a tenden W in favour of surgical treatment. In one of' the hospitals the differences reached statistical signicicance (p<0,01) tbe the patients without concurrent disease that attected QoL No dill?fences in symptoms and QoL were found between open and lapamscopic t\mdoplication. This study shows that surgical treatment of GERD is more effective in relieving reflux symptoms than the medical treatment given according to clinical practice in our regmn